Bottom Line:
The global prevalence of genital tuberculosis has increased during the past two decades due to increasing acquired immunodeficiency syndrome.Tuberculosis gives rise to various appearances on hysterosalpingography (HSG) from non-specific changes to specific findings.Part II will describe adverse effects of tuberculosis on structure of endometrium and radiological specific findings, such as "T-shaped" tuberculosis uterus, "pseudo-unicornuate "uterus, "collar-stud abscess" and "dwarfed" uterus with lymphatic intravasation and occluded tubes which have not been encountered in the majority of non-tuberculosis cases.

ABSTRACTFemale genital tuberculosis remains as a major cause of tubal obstruction leading to infertility, especially in developing countries. The global prevalence of genital tuberculosis has increased during the past two decades due to increasing acquired immunodeficiency syndrome. Genital tuberculosis (TB) is commonly asymptomatic and it is diagnosed during infertility investigations. Despite of recent advances in imaging tools such as computed tomography (CT) scan, magnetic resonance imaging (MRI) and ultrasongraphy, hysterosalpinography has been considered as the standard screening test for evaluation of tubal infertility and as a valuable tool for diagnosis of female genital tuberculosis. Tuberculosis gives rise to various appearances on hysterosalpingography (HSG) from non-specific changes to specific findings. The present pictorial review illustrates and describes specific and non-specific radiographic features of female genital tuberculosis in two parts. Part I presents specific findings of tuberculosis related to tubes such as "beaded tube", "golf club tube", "pipestem tube", "cobble stone tube" and the "leopard skin tube". Part II will describe adverse effects of tuberculosis on structure of endometrium and radiological specific findings, such as "T-shaped" tuberculosis uterus, "pseudo-unicornuate "uterus, "collar-stud abscess" and "dwarfed" uterus with lymphatic intravasation and occluded tubes which have not been encountered in the majority of non-tuberculosis cases.

Figure 2: Indentation of the cavity due to synechiae resemblesa denticulate uterus .Obstruction of the isthmic portion inboth tubes is present.

Mentions:
With progression of disease, irregularity ofuterine contour and filling defects may resultin a denticulate cavity (Fig 2) (18, 19), or mayconvert the triangular uterine cavity into a T-shape which is very similar to diethylstilbestroluteri (14, 19). A "T-shaped" tuberculosis uterusshould be differentiated from a "T-shaped" indiethylstilbestrol (DES) exposure. The characteristic appearances of DES uterus are usuallyT-shaped with multiple constriction bands, aboxlike lower uterine cavity, a narrow endocervical canal and a hypoplastic uterine cavity;however, the fallopian tubes are usually normal(Fig 3) (20). Sometimes, unilateral scarring ofthe cavity results in obliteration of cavity onone side of uterus giving rise to a unicornuateappearance called a "pseudounicornuate" uterus(19). True unicornuate uterus can be differentiated from a pseudo unicornuate uterus by having a smooth contour, a more horizontally oriented long axis and normal ipsilateral fallopiantube (Fig 4A, B) (14).

Figure 2: Indentation of the cavity due to synechiae resemblesa denticulate uterus .Obstruction of the isthmic portion inboth tubes is present.

Mentions:
With progression of disease, irregularity ofuterine contour and filling defects may resultin a denticulate cavity (Fig 2) (18, 19), or mayconvert the triangular uterine cavity into a T-shape which is very similar to diethylstilbestroluteri (14, 19). A "T-shaped" tuberculosis uterusshould be differentiated from a "T-shaped" indiethylstilbestrol (DES) exposure. The characteristic appearances of DES uterus are usuallyT-shaped with multiple constriction bands, aboxlike lower uterine cavity, a narrow endocervical canal and a hypoplastic uterine cavity;however, the fallopian tubes are usually normal(Fig 3) (20). Sometimes, unilateral scarring ofthe cavity results in obliteration of cavity onone side of uterus giving rise to a unicornuateappearance called a "pseudounicornuate" uterus(19). True unicornuate uterus can be differentiated from a pseudo unicornuate uterus by having a smooth contour, a more horizontally oriented long axis and normal ipsilateral fallopiantube (Fig 4A, B) (14).

Bottom Line:
The global prevalence of genital tuberculosis has increased during the past two decades due to increasing acquired immunodeficiency syndrome.Tuberculosis gives rise to various appearances on hysterosalpingography (HSG) from non-specific changes to specific findings.Part II will describe adverse effects of tuberculosis on structure of endometrium and radiological specific findings, such as "T-shaped" tuberculosis uterus, "pseudo-unicornuate "uterus, "collar-stud abscess" and "dwarfed" uterus with lymphatic intravasation and occluded tubes which have not been encountered in the majority of non-tuberculosis cases.

ABSTRACTFemale genital tuberculosis remains as a major cause of tubal obstruction leading to infertility, especially in developing countries. The global prevalence of genital tuberculosis has increased during the past two decades due to increasing acquired immunodeficiency syndrome. Genital tuberculosis (TB) is commonly asymptomatic and it is diagnosed during infertility investigations. Despite of recent advances in imaging tools such as computed tomography (CT) scan, magnetic resonance imaging (MRI) and ultrasongraphy, hysterosalpinography has been considered as the standard screening test for evaluation of tubal infertility and as a valuable tool for diagnosis of female genital tuberculosis. Tuberculosis gives rise to various appearances on hysterosalpingography (HSG) from non-specific changes to specific findings. The present pictorial review illustrates and describes specific and non-specific radiographic features of female genital tuberculosis in two parts. Part I presents specific findings of tuberculosis related to tubes such as "beaded tube", "golf club tube", "pipestem tube", "cobble stone tube" and the "leopard skin tube". Part II will describe adverse effects of tuberculosis on structure of endometrium and radiological specific findings, such as "T-shaped" tuberculosis uterus, "pseudo-unicornuate "uterus, "collar-stud abscess" and "dwarfed" uterus with lymphatic intravasation and occluded tubes which have not been encountered in the majority of non-tuberculosis cases.